Preface
Health assessment is central to nursing practice. By practising and developing the knowledge and skills of health assessment you will develop confidence in understanding and responding to each patient’s situation. You need to listen to the cues from your patients as these will guide and direct your questioning and physical examination. Whether you are an undergraduate nursing student, a newly qualified registered nurse or an experienced nurse seeking to advance your practice, this book holds the content you need to develop and refine your health assessment skills. The first edition of this text is contextualised to suit the Australian and New Zealand healthcare environments. We hope this text will become an invaluable part of your professional library and look forward to ongoing feedback from you, our readers.
The ANZ edition of Jarvis Physical Examination and Health Assessment has been fully revised and updated for the Australian and New Zealand contexts and structured to enhance learning for undergraduate and postgraduate students and clinicians.
Each chapter begins with an overview highlighting the importance and relevance of given topics to nursing practice. The introductory chapter describes the purpose of health assessment in nursing practice and how it contributes to a multidisciplinary patient assessment. All spelling, terminology, measurements, cultural and social considerations, clinical procedures and best practice reflect the Australian and New Zealand contexts.
• Updated table of contents to assist the reader to understand the relevance of the health assessment areas to the functional status of the person
• Each chapter contextualises the particular health assessment skills highlighting the importance and relevance of given topics to nursing practice
• New introductory chapter describes the purpose of health assessment in nursing practice and how this contributes to a multidisciplinary patient assessment
• New chapters on assessment of urinary and bowel function—key areas for nursing assessment in a variety of clinical settings including acute care, community health and aged care
• Each chapter has clearly identified health assessment skills for beginning and advanced clinicians.
Physical Examination & Health Assessment is a text for beginning students of health assessment as well as a text and reference for advanced practitioners. The chapter progression and format permit this scope without sacrificing one use for the other.
Chapters 1 to 5 Chapter 2 Chapter 3 Chapter 4 Chapter 5 focus on approaches and contexts of health assessment in nursing, including critical thinking, developmental tasks and health promotion for all age groups, cultural safety and screening for family violence and abuse.
Chapters 6 to 10 Chapter 7 Chapter 8 Chapter 9 Chapter 10 focus on health assessment tools and techniques, including the health interview and health history, physical assessment techniques, general survey, measurement vital signs and pain assessment.
Chapters 11 to 28 Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter 18 Chapter 19 Chapter 20 Chapter 21 Chapter 22 Chapter 23 Chapter 24 Chapter 25 Chapter 26 Chapter 27 Chapter 28 focus on the key areas for health assessment which are organised around functional areas relevant to nursing practice. Each chapter has five major sections: Structure and Function, Subjective Data (history), Objective Data (procedures and normal findings/abnormal findings and clinical alerts), Documentation and Critical Thinking, and Abnormal Findings. The beginning nurse can review anatomy and physiology and learn the skills, normal findings and common variations for generally healthy people and selected abnormal findings in the Objective Data sections. They will also be prompted to report and refer clinically significant abnormal findings. The advanced practice nurse will be able to review anatomy and physiology and fundamental health assessment skills, while focusing on the more complex knowledge and skills required for specialty nursing practice. Students can also study the extensive pathology illustrations and detailed text in the Abnormal Findings sections.
Chapters 29 and 30 focus on integrating health assessment in practice. Chapter 29 describes the complete health assessment using a head-to-toe approach for a complete screening examination in various age groups. Chapter 30 describes a more focused approach to assessment in response to a change in the patient’s condition.
Physical Examination & Health Assessment reflects a commitment to:
• Holism, in the focus on the individual as a whole, both in wellness needs and illness needs
• Health promotion, in the health history questions that elicit self-care behaviours, the age-specific charts for periodic health examinations, the Promoting a Healthy Lifestyle boxes, and the self-examination teaching presented for skin, breast, testicles and nutrition
• Interacting with the person as an active participant in healthcare, by encouraging discussion of what the person currently is doing to promote health and by engaging the person to participate in self-care
• Cultural considerations that take into account the global society in which culturally diverse people seek healthcare
• Individuals across the life cycle, supported by the belief that a person’s state of health must be considered in light of developmental stage. Chapter 3 presents a baseline of developmental tasks and topics expected for each age grouping, and subsequent chapters integrate relevant developmental content. Developmental anatomy, modifications of history taking and examination technique, and expected findings are given for infants and children, adolescents, pregnant females and ageing adults.
Physical Examination & Health Assessment is built on the strengths of the previous US edition and is designed to engage students and enhance learning:
1. The two-column format begins in the Subjective Data section, where the running column highlights the rationales for asking history questions. In the Objective Data section, the running column highlights selected abnormal findings to show a clear relationship between normal and abnormal findings.
2. Method of examination (Objective Data section) is clear, orderly and easy to follow. Hundreds of original examination illustrations are linked directly with the text to demonstrate the physical examination in a step-by-step format.
3. Abnormal Findings tables organise and expand on material in the examination section. The atlas format of these extensive collections of pathology and original illustrations helps students recognise, sort and describe abnormal findings. When applicable, the text under a table entry is presented in a Subjective Data–Objective Data format.
4. Developmental approach in each chapter presents prototypical content on the adult, then age-specific content for the infant, child, adolescent, pregnant female and ageing adult so that students can learn common variations for all age groups.
5. Cultural considerations are extensive throughout and present the expected variations for culturally diverse people.
6. Stunning full-colour art shows detailed human anatomy, physiology, examination techniques and abnormal findings.
7. Health history (Subjective Data) appears in two places: In Chapter 7, The complete health history, and in pertinent history questions that are repeated and expanded in each regional examination chapter, including history questions that highlight health promotion and self-care. This presentation helps students understand the relationship between subjective and objective data. Considering the history and examination data together, as you do in the clinical setting, means that each chapter can stand on its own if a person has a specific problem related to that body system.
Chapter 6, The health assessment interview, has the most complete discussion available on the process of communication, interviewing skills, techniques and traps and cultural considerations.
8. Summary checklists towards the end of each chapter provide a quick review of examination steps to help develop a mental checklist.
9. Focused assessment/clinical case studies of frequently encountered situations show the application of assessment techniques to patients of different ages in differing clinical situations.
10. Integration of the complete health assessment for the adult is presented in Chapter 29. This approach integrates all the steps into a choreographed whole.
11. User-friendly design makes the book easy to use. Frequent subheadings and instructional headings assist in easy retrieval of material.
• The EVOLVE Website (located at http://evolve.elsevier.com/AU/Jarvis/) provides lecturers with PowerPoints and Test Banks for each of the 30 chapters, an Image Collection, and a Student Lab Manual Answer Key. Students have access to Appendices, Multiple Choice Review Questions, Quick Assessments for 20 Common Conditions and WebLinks—in effect, a comprehensive online resource that takes advantage of the dynamic nature of electronic content and online delivery.
• The Pocket Companion for Physical Examination & Health Assessment is a handy and current clinical reference that provides pertinent material in full colour and includes illustrations from the textbook.
• The Student Laboratory Manual is a workbook that includes a student study guide for each chapter, glossary of key terms, clinical objectives, regional write-up forms and review questions.
• Health Assessment Online is an innovative and dynamic teaching and learning tool featuring comprehensive Self-Paced Learning Modules, which offer increased flexibility to lecturers who wish to provide students with tutorial learning modules and in-depth case studies for each body system chapter in the text. Animations, sounds, images, interactive activities, and video clips are embedded in the learning modules and case studies to provide a dynamic, multimodal learning environment for today’s learners. Health Assessment Online also provides Multiple Choice Review Questions exclusive to Health Assessment Online and which align to the ANZ text.
We would like to acknowledge the people who made the first Australian and New Zealand edition of this text possible:
• Vaughn Curtis, Elsevier Australia who at the time of commissioning this text was Australia’s Regional Director, for his initiative and support in establishing a team to make the adaption of this text possible.
• Luisa Cecotti, Libby Houston (Publishers) and Helena Klijn (Publishing Services Manager) for their support and persistence in keeping us on track.
• Larissa Norrie and Elizabeth Coady (Developmental Editors) for their support and keeping us organised and informed about the publishing process.
• Sybil Kesteven (Editor) for her outstanding attention to detail and for helping us to be better writers.
• Karen Griffiths and Lisa Shillan (Project Coordinators) for their efforts in transforming the manuscript into a textbook.
We would also like to thank our families for allowing us to take over our respective dining room table, computer and study over the past two and a half years. We thank them for their support and encouragement and for the endless cups of tea.
We would like to dedicate this edition to the nursing students and registered nurses who will use this text to develop their clinical skills. We encourage you to continually strive to develop and refine your health assessment skills. Your efforts will contribute to improving the patient/client experience and the overall quality and safety of nursing care.
The publisher and editors would also like to thank each of the chapter contributors and reviewers who ensured the relevance, accuracy and strong clinical application of the content. As an adaption of an existing text we would also like to acknowledge past contributors and reviewers who provided a strong foundation on which we could build.